Der Internist
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Review
[Adjuvant chemotherapy of solid tumors of the gastrointestinal tract: where is the progress?].
Surgical therapy of any malignancy always attempts the complete removal of a cancer from the organism. An adjuvant chemotherapy has the goal to remove remaining tumor-cells, to prevent recurrence of the disease and to improve long term survival. Within the last years there has been a substantial improvement in prognosis due to multi-modal therapeutic regimens including combination-chemo-therapy and innovative radiation-protocols. This review aims to present and to critically review current concepts in the treatment of selected tumors of the gastrointestinal tract.
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Cardiogenic shock after acute myocardial infarction continues to exhibit a high mortality rate. The prognosis can be improved with acute revascularization. ⋯ New treatment approaches such as the calcium sensitizer levosimendan, NO synthase inhibition, complement inhibition, or vasopressin therapy have not yet yielded convincing results. Future therapies will likely address the anti-inflammatory aspect of cardiogenic shock.
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The multiple myeloma (MM) has an incidence of 3-4/100,000 in the Caucasian population. MM has to be distinguished from smouldering MM and monoclonal gammopathy of uncertain significance (MGUS). In younger patients (<65 years) a good long-term remission is the aim of therapy, while in the elderly patients with comorbidities the aim is a good partial remission with good quality of life. ⋯ High-dose chemotherapy, often as a tandem transplantation, is part of standard therapy of MM patients <65 years. However, allogeneic stem cell transplantation is the only curative approach. New substances approved for treatment of relapsed MM include bortezomib, thalidomide, and lenalidomide.
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The introduction of Drug Eluting Stents was an important step to reduce restenosis rate after coronary stent implantation. Unfortunately, reduction of restenosis was paid off by the price of potential increased late (>30 days) stent thrombosis. However, current data are not completely conclusive with respect to extent and duration of stent thrombosis and cardiovascular risk after drug eluting stent implantation. ⋯ However in selected high-risk patients (e.g. left main or multivessel stent implantation) control angiography may be useful. Medical therapy of risk factors (hyperlipidemia, hypertension, and diabetes mellitus) is essential also after coronary stent implantation. It is important to screen patients for diabetes mellitus, since approximately 1/3 of patients after coronary intervention have an otherwise unrecognized diabetes mellitus or glucose tolerance disturbance.